1578604989 NPI number — CHAD MICHAEL SMITH MD

Table of content: CHAD MICHAEL SMITH MD (NPI 1578604989)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578604989 NPI number — CHAD MICHAEL SMITH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
CHAD
Provider Middle Name:
MICHAEL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578604989
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/10/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
920 STANTON L. YOUNG
Provider Second Line Business Mailing Address:
WP 2430
Provider Business Mailing Address City Name:
OKLA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-271-7449
Provider Business Mailing Address Fax Number:
405-271-8762

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
825 NE 10TH
Provider Second Line Business Practice Location Address:
SUITE 3300
Provider Business Practice Location Address City Name:
OKLA CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-271-5239
Provider Business Practice Location Address Fax Number:
405-271-3727
Provider Enumeration Date:
02/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  25014 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com